QuoteReplyTopic: H1N1 virus more virulent this year Posted: February 14 2017 at 8:40am

H1N1 virus more virulent this year, severely affects people aged over 40

COIMBATORE: Even as the health department continues to downplay the deaths due to the H1N1 virus, officials admitted that the seasonal flu has been more virulent this year. Dr K Kolandaisamy, director of public health, said the virus is affecting patients above the age of 40 more severely than last year. Many of these patients, after getting infected, have been contracting pneumonia, as a result of which they condition rapidly deteriorates.

"The H1N1 virus, like all other viruses, has its strains changing or mutating every year," said Dr Kolandaisamy. "This year, people above the age of 40 have been badly affected," he said. This comes after reports that the disease, which starts off as a sore throat and fever in patients, progresses to severe pneumonia in hardly three days even in patients who do not suffer from other complications. "However, the good news is that it is not affecting pregnant women too severely, unlike in 2009-10 when many women in Kerala died," he said.

Though there have been more than seven deaths purely due to the H1N1 virus in the government hospital alone, the public health department insisted that there have been only three deaths due to the virus. Speaking at a H1N1 virus prevention event at PSG Tech, Dr Kolandaisamy said, "There have been only three deaths in Coimbatore and Tirupur due to the H1N1 virus, but there have been other deaths due to comorbid conditions like renal failure and uncontrolled sugar. Those patients may have also tested positive for the virus".

The director admitted that around two to three patients have been testing positive for the virus every day since the end of December. "Around 30% of them are category C patients, or those with other comorbid conditions, be it senior citizens or pregnant women," said Dr Kolandaisamy. "These are the patients to be worried about as the H1N1 virus worsens their other problems. These patients have to ensure their sugar, blood pressure and other health issues are under control," he said.

That's interesting, arirish. I bookmarked an online article on my tablet yesterday by the Times of India that said something very similar - that they believed that H1N1 had become more virulent. After I'd read it (I was at work), I spoke to two people that were getting over severe bronchitis after contracting the flu. Both were under 40, and one told me she had tested positive for an influenza A strain. Whatever's showing up late in the flu season seems to be hitting those who were vaccinated as badly as those who didn't, possibly indicating a new strain or significant mutation.

The thing that's been bothering me is that back in 1918, the first pandemic wave was an unusually severe flu season that persisted into early summer. Interestingly, this year's flu season appears to be a particularly bad one, and it's been predicted to last longer than usual.

I'm not suggesting that we're on the cusp of a pandemic, but it behooves us to pay attention to past outbreaks and the patterns they often follow. Historically, pandemics have been cyclical - three every century if the last 400-500 years are anything to go by - and in the ratio of two minor to one major outbreak.

It's been 99 years since Spanish Flu killed millions, and in that time we've seen three minor pandemics (1957 Asian Flu, 1968 Hong Kong Flu, and 2009 H1N1). Both statistics should put us on alert that we're due, and we have a few candidates padding out their resumes as I write this. Will H1N1 revisit it's old host as it did almost a century ago, or will the torch be passed to an upstart like H7N9?

Viruses mutated and reassorted according to chance in years past - that's not the case anymore. We're susceptible to avian and swine flu viruses, and yet we cram immune compromised poultry and pigs into sheds that are also accessible to potentially infected wild animals looking for a free meal. Viruses freely infect and co-infect hosts in their hundreds of millions under conditions like that, producing novel strains at a rate we've never seen before. Habitat degradation, bush meat and live markets also expose us to previously unknown strains, and allow them to pass into human populations with absolutely no immunity. In short, we're making the viruses that could spark the next pandemic, and in unprecedented numbers.

Hopefully, we're still talking about this in ten years, but the world was caught completely off guard in 1918, and I predict it will be again because we never seem to pay attention to the writing on the wall. Prep now and hope you never need them, but don't think that waiting is ever going to be the best strategy.

"Buy it cheap. Stack it deep""Any community that fails to prepare, with the expectation that the federal government will come to the rescue, will be tragically wrong." Michael Leavitt, HHS Secretary.

Remember that The 1918 Pandemic killed in three waves spread out over around 10 months. At this time it was initially not thought that this was even the disease called influenza. Eventually, however, this became accepted. The causative agent was believed to be Haemophilus influenzae (hence its name), a bacteria. No vaccine existed at this time.

Compare that with the 2009 H1N1 pandemic where clinical trials for vaccines were being conducted in 3 months of the first laboratory confirmed case (April 15th to July 22nd). Mass production of vaccines began in earnest in less than four months and by five months nearly five vaccines were approved by the FDA. On October 5th, 2009--24 weeks and 4 days, just over 6 months--the first doses of an effective were administered to vulnerable populations.

We are worlds ahead in terms of preparation, detection, prevention, and even treatment. It is quite likely that the events (including deathtoll) of The Pandemic will not be repeated to the same extent ever again. Our knowledge on how to combat influenza has been paid for with many, many lives, however.

I have to disagree. Spanish Flu ravaged a world more robust and self sufficient than today's. We are far less ready than we were back in 1918. What we call prepping was just commonsense back then - people prepared for lean times because they knew from experience that periods of plenty were often followed by hardship. We haven't seen that pendulum swing in our lifetime, and consequently prepping is considered fringe now. Most modern households are lucky to have more than a few days worth of food and water.

Let me be clear - 2009 was a minor pandemic, and I'm talking about a major pandemic virus capable of sidelining as much as a third of the population for weeks at a time, and killing many millions in a short period. We would see every link in our global supply chains collapse if one in three workers were seriously sickened, even without factoring in social distancing. The production and delivery of food would be seriously impacted, as would energy production, healthcare, transportation, access to clean water, law enforcement, and a functioning government at every level. They would be no demographic unaffected.

Back in 1918, many people grew their own food or lived close enough to farms that they didn't starve. Imagine protracted food shortages in every urban community - where would the residents (without gas in their cars, or access to a functioning public transportation system) find food when the shelves emptied - the federal government, maybe? They were overwhelmed by disasters like Katrina, so saving hundreds of New Orleans would be an impossible task, particularly in light of proposed cuts to FEMA's budget by the Trump administration. And even if people could even reach growing areas, would farms be able to function as they did in 1918? Probably not, and for several reasons.

Electricity was not widely available back then, and farms didn't rely on regular deliveries of gas and diesel to fuel their equipment - human or animal power was the driving force. A certain amount of the year's harvest was kept back to replant the following year, and what we now call heirloom varieties were the norm - prized for their diversity, and consequently their natural resistance to any one pest. Modern agriculture has now transitioned to an industry dedicated to growing far fewer types of hybrid plants that require vast amounts of pesticides and fertilizers to thrive. Replanting hybrid crops the following year doesn't work, so deliveries of seeds from companies like Monsanto are essential at the start of each growing season. And the same vulnerabilities apply to food animals - without power, water, medications and food, farms that intensively raise them would quickly fail.

Vaccine production would be hit as hard as any field, so don't expect that to save us. Even if the next major pandemic followed the same pattern as 1918 and peaked with it's second wave, we couldn't hope to develop and produce enough to vaccinate billions against a novel virus with the lead time a first wave would give us. In 2009, adjuvants were considered to bolster an already insufficient supply of vaccine, and in expectation of shortages, pandemic planning calls for select groups (tiers) to be vaccinated first. Military, law enforcement, and government officials are given priority, as are certain healthcare professions - but most people are way down the list.

Without a doubt, hospitals would be completely overwhelmed. A bad flu season can see emergency rooms overflowing - increase that number by ten, and you'd see chaos. Multiply it by a hundred and you see complete collapse of every healthcare system. With an estimated 62,000 ventilators in the US and far more people needing them, every ICU would soon be swamped - assuming they could function without power, medical supplies and a third of their staff too sick to work. Without access to the advanced care they provide, many people would be sent home to die in the care of their families, potentially infecting them.

Sorry to be so doom and gloom, but we've painted ourselves into a corner that we expect someone else to get us out of. The truth is that they will be in the same position as us. In short, the shelves would empty, the hospitals would close, the faucets would run dry, and the lights would go out - and
there would be no cavalry coming to save us because they would be dying
too.

In 1918, the second wave lasted three months and killed 90% of all the victims of Spanish Flu. Most estimates now put the death toll at between 50 and 100 million. That's 45-90 million dead in a 90 day period (let that sink in for a second - as many as a million deaths a day) in a world with a population a quarter of today's seven billion. Something akin to Spanish Flu would kick our collective butts with ease - and viruses like H7N9 are unfortunately looking far deadlier.

"Buy it cheap. Stack it deep""Any community that fails to prepare, with the expectation that the federal government will come to the rescue, will be tragically wrong." Michael Leavitt, HHS Secretary.

The world in 1918 was in all relevant ways not as robust as we are currently. The pathogen and mode of spread was initially unknown. The pathogen was then not even understood to be a virus. The US military, though practices not mirrored today, all but fueled the pandemic from relative midwest obscurity to the global scourge it was. Proper quarantine and general hygiene was barely a factor throughout The Pandemic.

By the 1918 timeline we would have vaccines already in trials for the second wave and administered before its conclusion. Or, realistically, would be quarantining people in Kansas and the midwest after a novel influenza virus popped up with fifty times the normal case fatality rate. In any case, vaccine production would not be hit hard at all, really.

The second wave aggregate death estimate seems high, even for 1918 Influenza. What is your source stating 90% of all 1918-1919 mortalities occurred within the main wave?

Knowing the name of the virus that's cutting the legs from under us as it sweeps around the globe won't be enough to stop a novel influenza virus that becomes efficiently H2H and kills at least as well as Spanish Flu. We have no effective anti-virals, and simply because a vaccine is in trials doesn't mean it'll be available in any appreciable amounts when it's needed - possibly a few months later. For the most part, vaccine production takes place abroad and in a far more limited capacity than people realize - and that also raises the specter of countries that manufacture them vaccinating their own citizens first when faced with a truly devastating virus. Read up on the conflict between vaccine manufacturers and Indonesia to see how politics (and big business) can potentially play a role in what should be a unilaterally philanthropic endeavor. Despite the global consequences, for a while Indonesia stopped allowing western scientists to collect H5N1 samples when it became apparent that it wouldn't necessarily guarantee them access to a vaccine.

We are nowhere near as robust as our grandparents and great-grandparents, or the society they lived in - not by a long way. These people were a few generations away from the pioneers that clawed their way to the farthest reaches of the world. They faced a major pandemic AND a world war at the same time and prevailed. I'm not sure where your faith in modern society stems from, because nothing I've read or heard in over a decade of prepping gives me that kind of warm, fuzzy feeling. We rely heavily on technologies that would fail quickly in a major pandemic - technologies that were not a factor in 1918. Our widely used "just in time" business model alone has the potential to bring us to our knees if supply lines are interrupted. I admire your optimism, but I don't share it. My reason for prepping is to hope for the best, but prepare for the worst. Anything else is folly, in my opinion. To assume we'll be taken care of, presumably by the federal government, flies in the face of everything we've seen in recent years. Even without the current administration's proposed cuts to FEMA's budget, they couldn't possibly cope with a major pandemic. Look at their response to Katrina. One city and they were in over their head. And if you pay close attention, they're even telling us - Michael Leavitt's quote at the bottom of this post couldn't be any clearer. And when his predecessor Tommy Thompson left office as HHS Secretary, he admitted that nothing he'd been briefed on scared him more than the prospect of a major pandemic, and specifically our inability to deal with it. These people are shouting from the rooftops that they'll be unable to help.

One thing you'll find when researching pandemics are opinions and conjecture, especially a century removed from the last big one. With regard to the death tolls attributed to Spanish Flu, there is no concensus. Typically ranging from 20 million to 100 million, it covers the ground from officials eager to placate the masses, to cheery souls like myself. Record keeping was sketchy at best in 1918, especially in remote locations, but the numbers have risen over the past few decades as other scientific fields such as epidemiology have weighed in on the subject. Which number is right? That's a matter of opinion - I don't know what figure you feel comfortable with, but I have a feeling that it's a lot less than mine. I've read a lot of arguments advocating both ends of the scale, and 50-100 million is what I choose to believe. And the figure I quoted is one I've seen in print a few times. If I can find an online reference, I'll post it. But here's the thing - the first wave in 1918 was characterized as nothing more than a particularly bad flu season, and the third wave was H1N1's last gasp as it circled the globe only to find it's new host either immune or dead. So what do you think the second wave was like? When we talk about the pandemic of 1918, it's always the second wave that's referenced. Bodies stacked like cordwood because there were too few healthy people to bury them, coffins in short supply, people dead a day or two after the onset of symptoms, hospital beds full in every affected city - all the second wave. It was an ass-kicking on a scale the world hasn't seen in a century, all packed into a three month period. Everything I've read about it scares the bejeezusus out of me, because no protocol or technology we have in place would stop it happening again.

I appreciate you have a much rosier view of past and future pandemics than me, but I have to ask - what's your motivation to post on a prepping site when you seem apparently unfazed by the prospect of a novel virus going H2H? I'm here because I'm fully expecting something that will have us referring to events as either before the pandemic, or after it. I'm just curious - alternative views are welcome here but we don't often see people telling us it'll all be okay. Hoping for the best, and preparing for the best is typically the mindset of a non-prepper, and we don't often hear it on AFT.

Thanks for the welcoming to the site! I was invited to browse by a reddit user since we crossed paths on an influenza related post. I've commented a couple of times under the handle Guest8. I'm an influenza fanatic, though I would not say I'm a prepper in the same sense you (and likely the rest of the site) would use it. I too share a "when, not if" approach with respect to flu pandemics, but I am trying to prep to prevent such an outcome or greatly reduce the brunt of a pandemic.

I am most definitely not unfazed by the prospect of H2H avian, but, like you identified, I am far more optimistic at our current capabilities in detecting potential crossover strains as well as reactively creating therapeutics even when caught completely flat-footed by a pandemic. More relevantly to our personal discussion, while society globally would be struck down harder by a 1918-level pandemic, we are far more prepared in preventing it from reaching that point. It's that last bit where my optimism stems from.

When I was introduced to the site it was not advertised as a prepping site but more just a place to talk about flu. Clearly it is both, and I am glad there's a community that is dedicated to collecting various news on avian and seasonal flu.

The prepping thing kind of catches you unawares, so be warned. It starts innocently enough with a couple of simple things you think it might be prudent to stock up on (my wife's asthma meds, in my case) and next thing you know, the garage is full of buckets of food, boxes of candles and enough medical supplies to keep a hospital running

It's nice to have someone join who gets this stuff, even if we don't all agree. Discussions aren't particularly useful if they're too one-sided, and I like to think that's what makes AFT stand out. Many sites - and I'm not necessarily singling out flu/prepping sites when I say this - don't tolerate dissent or discussion, especially if it's the new guy against the seasoned poster. I know, because I've experienced it elsewhere and it left enough of a bad taste that I rarely go back. And titles don't necessarily mean as much here as they do elsewhere either. For the most part, members of the moderator group on AFT just try to keep discord/abuse to a minimum, and stay on top of any spam that pops up.

Hopefully you stick around - your posts are certainly insightful and very well-informed, and that can only be an asset to a site like this. And don't forget to buy some extra cough medicine next time you're at the store...

"Buy it cheap. Stack it deep""Any community that fails to prepare, with the expectation that the federal government will come to the rescue, will be tragically wrong." Michael Leavitt, HHS Secretary.

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